MS ankle foot special tests/ knee lab Flashcards
PROM motions at each joint... hindfoot (2 joints/ 2 movements) midfoot forefoot (2 movements at 1 joint)
then next progression
hindfoot:
talocrual: DF/PF
subtalar: inversion/eversion
midfoot:
ab/aD of midtarsals
forefoot:
flex/ext
ab/ad at phalangeal
progress to resisted isometric
cyriaxs ankle/ foot
WB & non- WB (8)
what to do if it elicits pain or no pain
active movements in both WB and non: in WB have pt walk on heels and toes PF/DF pro/sup toe flex/extend, aB/ad
if no pain => PROM and test for end feel
all end feels should be tissue stretch
resisted motion (4 sets)
in resting position: knee flex (to check gastroc and soleus) PF & DF w/ hip/ knee at 45/90 sup/pro toe ext/flex
muscles tested for toe flexion (8)
- flexor digitorum longus (2) brevis
- flexor hallucis longus (4) brevis
- flexor digiti minimi brevis
- dorsal (7) palmar interossei
- lumbricals
muscles tested during toe extension (4)
- extensor digitorum longus (2) brevis
- extensor hallucis longus
- lumbricals at IP joints
muscles tested for aBduction of toes (3)
- abductor hallucis
- abductor digiti minimi
- dorsal interossei
muscles tested for toe aDduction (2)
- adductor hallucis
2. plantar interossi
ankle ROM necessary for
descending stairs
walking
descending stairs: full DF = 20 degrees
walking:
DF 10 degrees
PF 20-25 def
2 tests to establish subtalar neutral
normal deviation
what it means if deviated
- palpation method- pt prone, hold talus and swing calc until no “bulge” on either side
- pt prone, make marks on…
1cm distal to calceaneal insertion (in middle)
middle of tib 1/3 down
use goniometer to measure
if inverted = hindfoot varus
if everted = hindfoot valgus
normal is 2-8 degrees
testing for position of talus in WB
(-) finding
pt standing relaxed, hold talus with thumb and index finger and have pt rotate trunk med/ lateral
negative= talus remains neutral = no buldge
“too many toes”
what you do
normal finding
what an abnormal finding can mean (3)
pt stands relaxed and view from behind how many toes are visible
should see 2-2.5 toes
“too many toes” can be from:
forefoot abduction
heel is in valgus
tib laterally rotated
tibial torsion
normal angle
if >
if <
normal angle of tibial torsion = 12-18 deg
if >18 = too much ER
if <12 = too much IR
ankle anterior drawer sign
which ligaments are u testing (2)
3 positions for test
testing anterior talofibular ligament
anterior talocalcaneal ligament
3 positions:
- supine: draw talus forward (stabilize tib/fib)
- hip/knee/ ankle flexion: push leg back
- prone: stabilize talus and pull tib/fib towards you
leg length test to determine where insufficiency is coming from
in standing, observe relationships btwn
ASIS -> ASIS
PSIS -> PSIS
ASIS -> PSIS
reposition pt with talar neutral
if no change, insufficiency is from pelvis or SI
thompson test
what we are testing
how we test
(+) finding
testing for integrity of Achilles’ tendon
pt prone and relaxed, squeeze gastroc. should elicit PF…
(+) sign is no response, but if tear is not significant, will still see some movement
neurological tests for ankle foot:
2 dermatomal
abnormal reflexes
L4-L5 test- posterior tib
S1-S2 achilles
babinski- abnormal sign is DF great toe, fanning digits
toe deformities claw toe hammer toe mallet toe morton toe
claw toe- hyperE MTP, flex DIP & PIP
hammer toe- hyper E MTP, flex PIP
mallet toe- flex DIP
morton toe- 2nd toe longest (may hypertrophy b/c extra stress)
hallux valgus
def
normal (and non) values 3
increase in MTP of big toe so much that may start to overlap with 2-3 toe (or go under them)
8-20 degrees = normal
20-30 degrees = congrous
>30 degrees = pathological
pes planus
test
pes cavus
problems it can cause
pes planus test = feiss line
draw a line from med mall => 1st MT
go to stand, if navicular drops below = pes planus
pes cavus= increased WB on heel & MTs => callus
diff dx arterial ulcer vs. venous ulcer
aterial ulcer feels better when leg is down because more blood circulating
venous ulcer feels better when legs are elevated b/c relieves pressure
some knee pain scales (3)
- anterior knee pain scale
- LE functional scale
- global rating of change form**
really good if pt says nothing is getting better but you see improvement => objective measure
amt of knee flexion needed for... swing phase of gait up stairs down stairs sit tie shoes
swing phase of gait = 65 deg
up stairs = 85 deg
down stairs = 90 deg
sit = 95
tie shoes = 105which direction to I push/ pull if my pt is limited in flexion?
3 optional positions
push tibia posterior b/c concave on convex
can do in sitting
on table (anterior drawer)
legs off table with distraction
supine
prone with knee bentwhich direction to I push/ pull if my pt is limited in extension?
specific treatment for terminal ext
pull anterior because concave tib moving on convex
terminal ext- do dorsal glide of femur
have pt supine, knee as close to end range ext as possible
stabilize tib and give posterior force on femur
